Vascular Reconstruction Is Not Warranted in Most Civilian Traumatic Shank Vascular Injuries

Francisco Igor B Macedo, Jason D. Sciarretta, Steve Chausse, Danny Sleeman, Louis R Pizano, Nicholas Namias

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Operative management of traumatic shank vascular injuries (SVI) evolved significantly in the past few decades, thereby leading to a dramatic decrease in amputation rates. However, there is still controversy regarding the minimum number of patent shank arteries sufficient for limb salvage. Methods: Between January 2006 and September 2011, 191 adult trauma patients presented to an urban level I trauma center in Miami, Florida, with traumatic lower extremity vascular injuries. Variables collected included age, gender, mechanism of injury, and clinical status at presentation. Surgical data included vessel injury, technical aspects of repair, associated complications, and outcomes. Results: A total of 48 (25.1%) patients were identified comprising 66 traumatic shank arterial injuries. Mean age was 38.2 ± 13.4 years, and the majority of patients were men (40 patients, 83.3%) presenting with blunt injuries (35 patients, 72.9%). Ligation was performed in 38 injured arteries (57.6%) and no vascular intervention was required in 20% of the patients. Vascular reconstruction was performed in only 6 patients (9.1%): 4 (6.1%) with concurrent popliteal trauma, 1 (1.5%) isolated anterior tibial, and 1 (1.5%) 3-vessel injury. Autogenous venous interposition conduit and polytetrafluoroethylene grafting were performed in 5 (7.6%) and 1 (1.5%) patient, respectively. All amputations (8 patients, 16.7%) occurred in blunt trauma patients presenting with unsalvageable limbs. The overall mortality rate in this series was 2.1%. Conclusions: Civilian shank arterial injuries are associated with acceptable rates of limb loss. Patients with a single-vessel patent inflow did not require vascular reconstruction in this series. Arterial reconstruction may no longer be determinant for successful management of isolated and double arterial SVI, whereas it is yet essential in the presence of 3-vessel or concurrent above-the-knee vascular injuries. Further investigation including larger number of patients is still warranted to define the role of conservative management in these complex injuries.

Original languageEnglish (US)
JournalAnnals of Vascular Surgery
DOIs
StateAccepted/In press - Jun 24 2015

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Vascular System Injuries
Blood Vessels
Wounds and Injuries
Amputation
Extremities
Arteries
Knee Injuries
Limb Salvage
Nonpenetrating Wounds
Trauma Centers
Polytetrafluoroethylene
Ligation
Lower Extremity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Vascular Reconstruction Is Not Warranted in Most Civilian Traumatic Shank Vascular Injuries. / Macedo, Francisco Igor B; Sciarretta, Jason D.; Chausse, Steve; Sleeman, Danny; Pizano, Louis R; Namias, Nicholas.

In: Annals of Vascular Surgery, 24.06.2015.

Research output: Contribution to journalArticle

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title = "Vascular Reconstruction Is Not Warranted in Most Civilian Traumatic Shank Vascular Injuries",
abstract = "Background: Operative management of traumatic shank vascular injuries (SVI) evolved significantly in the past few decades, thereby leading to a dramatic decrease in amputation rates. However, there is still controversy regarding the minimum number of patent shank arteries sufficient for limb salvage. Methods: Between January 2006 and September 2011, 191 adult trauma patients presented to an urban level I trauma center in Miami, Florida, with traumatic lower extremity vascular injuries. Variables collected included age, gender, mechanism of injury, and clinical status at presentation. Surgical data included vessel injury, technical aspects of repair, associated complications, and outcomes. Results: A total of 48 (25.1{\%}) patients were identified comprising 66 traumatic shank arterial injuries. Mean age was 38.2 ± 13.4 years, and the majority of patients were men (40 patients, 83.3{\%}) presenting with blunt injuries (35 patients, 72.9{\%}). Ligation was performed in 38 injured arteries (57.6{\%}) and no vascular intervention was required in 20{\%} of the patients. Vascular reconstruction was performed in only 6 patients (9.1{\%}): 4 (6.1{\%}) with concurrent popliteal trauma, 1 (1.5{\%}) isolated anterior tibial, and 1 (1.5{\%}) 3-vessel injury. Autogenous venous interposition conduit and polytetrafluoroethylene grafting were performed in 5 (7.6{\%}) and 1 (1.5{\%}) patient, respectively. All amputations (8 patients, 16.7{\%}) occurred in blunt trauma patients presenting with unsalvageable limbs. The overall mortality rate in this series was 2.1{\%}. Conclusions: Civilian shank arterial injuries are associated with acceptable rates of limb loss. Patients with a single-vessel patent inflow did not require vascular reconstruction in this series. Arterial reconstruction may no longer be determinant for successful management of isolated and double arterial SVI, whereas it is yet essential in the presence of 3-vessel or concurrent above-the-knee vascular injuries. Further investigation including larger number of patients is still warranted to define the role of conservative management in these complex injuries.",
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